Application Form
Desired Financing Amount $
Financing will be used for
Working Capital
Debt Restructure
Business Acquistion/Partner Buyout
Revenue Based Working Capital
Other
Contact Information
Name
Title
First Name
Last Name
SSN
Date of Birth
E-mail
example@example.com
Phone
Format: (000) 000-0000.
Are you the sole Owner of the Business
Yes
No
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Information
Business Name
Years in Business
0-1 Year
1-2 Years
3-4 Years
5+ Years
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Monthly rent/mortgage
EIN
Business Start Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current MCA Positions
Yes
No
More than 3 Positions
Annual Revenue
Please Select
Startup
Under $100,000
$100,000-$199,000
$200,000 - $499,000
$500,000 - $999,000
Over $1,000,000
Approximate Credit Score
Please Select
Under 600
600-640
640-660
660-700
700+
Please Describe the Use of Proceeds
Consent
Signature
The Company and the undersigned principal owner of theCompany identified above (“Applicant”) represents, acknowledges, and agreesthat (1) all information and documents provided to ARF Holdings LLC(“Provider”) are true, accurate, and complete, (2) Applicant will immediatelynotify Provider of any change in Applicant's financial condition, (3) Bysigning below, the business and each undersigned owner or principal(“Applicant”) authorizes the party receiving this application, and itssuccessors, assigns and designees, including other brokers and fundingintermediaries (“Broker”), to share, transmit, and reproduce this applicationand all supporting documents for the purpose of assisting the Applicant inobtaining commercial financing and funding products. If a funding intermediaryor source requires a different application format, Applicant appoints Broker asits limited agent to complete and submit the information contained in this applicationand its supporting documents on such form, and Applicant adopts the signaturebelow as Applicant’s authorized, valid, and binding signature which Broker mayapply on its behalf on each such submission. This authorization shall continueuntil revoked by Applicant in writing. (collectively"Recipients"), (4) such Recipients are authorized to request andreceive any investigative reports, consumer credit reports, statements fromcreditors or financial institutions, verifications of information, or any otherinformation that Recipients deem necessary in considering this Application, (5)the undersigned represents that they are authorized to sign this form on behalfof the Company, and (6) THE COMPANY AND PRINCIPAL CONSENT TO RECEIVE CALLS,TEXTS, AND EMAILS FROM PROVIDER AND RECIPIENTS BASED UPON THE CONTACTINFORMATION OF APPLICANT PROVIDED IN THIS APPLICATION.
YES
Send Application Now
Send Application Now
Should be Empty: